Healthcare Provider Details

I. General information

NPI: 1003812637
Provider Name (Legal Business Name): AMBULANCE ENTERPRISES, INC D/B/A INDIANA EMS
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/28/2005
Last Update Date: 08/04/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2816 W. SAMPLE ST.
SOUTH BEND IN
46619-3230
US

IV. Provider business mailing address

2816 W. SAMPLE ST.
SOUTH BEND IN
46619-3230
US

V. Phone/Fax

Practice location:
  • Phone: 574-289-0725
  • Fax: 579-289-4662
Mailing address:
  • Phone: 574-289-0725
  • Fax: 579-289-4662

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code3416L0300X
TaxonomyLand Ambulance
License Number0398
License Number StateIN
# 2
Primary TaxonomyY
Taxonomy Code341600000X
TaxonomyAmbulance
License Number
License Number State

VIII. Authorized Official

Name: MS. ROBIN I. ROBERTS
Title or Position: BILLING MGR.
Credential:
Phone: 574-289-0725